Living Well with Heart Failure

Dear Patient,

Thank you for choosing Scripps for your heart failure care. This educational series is designed for you to gain a better understanding of what you are experiencing. You will learn in this series what heart failure is, and how to:

Participation in your own care is very important to your success in living with heart failure. We are committed to giving you the best care and would like to make a “Heart to Heart” agreement with you as partners in care. To obtain the best outcomes possible, we would like you to commit to the following:

I will…

Patient Name: Patient Signature:

Thank you,

Your Health Care Team

• Identify your symptoms• Set goals for your care• Stay safe

• Choose the right nutrition• Manage your medications• Get started with your care at home

1. Take my medications as prescribed2. Weigh myself daily3. Record my symptoms daily

4. Notify my health care team of any problems5. Follow my diet6. Exercise as directed

What is Heart Failure?When you have heart failure, your heart doesn’t pump as well as it should. Because of this, some parts of your body may not get enough blood and oxygen.

Understanding Heart FailureThe heart is a muscle. It pumps oxygen-rich blood to all parts of the body. When you have heart failure, the heart can’t pump as well as it should. Blood and fluid may back up into the lungs, and some parts of the body don’t get enough oxygen-rich blood to work normally. These problems lead to the symptoms you feel.

1

How a Healthy Heart Pumps BloodAs the heart beats, blood constantly moves through it. The heart muscle must pump out (eject) enough of this blood to keep the body healthy. Oxygen-poor blood (shown with blue arrows) goes through the right side of the heart to the lungs. Oxygen-rich blood (red arrows) goes through the left side of the heart to all other parts of the body. Each heartbeat has two steps:

Step 1. The atria (upper chambers) relax and fill with blood entering the heart. At the same time, the ventricles (lower chambers) squeeze to pump blood out of the heart to the lungs and the body. This part of the heartbeat is called systole.

Step 2. The atria squeeze to send blood into the ventricles. The ventricles relax to receive this blood. This part of the heartbeat is called diastole. The process starts over with the next heartbeat.

What is Ejection Fraction? Ejection fraction (EF) measures how much blood the heart pumps out (ejects). This is a measure to help diagnose heart failure. A healthy heart pumps at least half of the blood from the ventricles with each beat. This means a normal ejection fraction is around 50 percent or more.

Causes, Incidence, and Risk FactorsHeart failure is almost always a chronic, long-term condition, although it can sometimes develop suddenly.

Common causes of heart failure include:1. Hypertension2. Coronary artery disease 3. Viral infection4. Toxins (chemotherapy, alcohol or illicit drugs)5. Heart valve disease

My Ejection Fraction

Date: Ejection Fraction:

Test used:

Heart failure is often classified as either low ejection fraction or normal ejection fraction heart failure. • Low ejection fraction heart failure means that

your heart muscle cannot pump, or eject, the blood out of the heart very well.

• Normal ejection fraction heart failure means thatyour heart’s pumping chamber is stiff and the pressure within the heart is too high.

With these problems the heart is either no longer able to pump enough blood out to the rest of your body or the pressure within the heart is high so that fluid may build up in the body or lungs.

As the heart’s pumping action is lost, blood may back up in other areas of the body, producing congestion in the lungs, the liver, the gastrointestinal tract and the arms and legs. As a result, there is a lack of oxygen and nutrition to organs, which damages them and reduces their ability to work properly.

Recognizing Heart Failure Symptoms

It’s up to you to pay attention to your

body and how you feel every single day.

Know Your BaselineThe first step to managing heart failure symptoms is getting to know what’s normal for you. This is considered your baseline. Knowing your baseline will help you see when symptoms are getting worse. You’ll know because you won’t feel normal anymore.

How Does Heart Failure Feel?You may have many heart failure symptoms or only a few. Below are the most common symptoms:• Shortness of breath, wheezing or coughing

when you exert yourself• Feeling weak or tired after little effort• Problems breathing when you’re lying flat, or the

need to sleep in a recliner or propped up on pillows• Waking up at night coughing or short of breath• Rapid weight gain• Swelling in the hands, abdomen, ankles or feet

Wh

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2

Track Your Symptoms Daily Signs and symptoms of worsening heart failureDo you know what to do when you notice the symptoms below? For each one, work out a plan with your health care provider.• Rapid weight gain means fluid is backing up in

your body. Gaining two or more pounds in one day, or five or more pounds in one week, are signs of worsening heart failure.

• Shortness of breath is caused by fluid backing up into the lungs. You may get winded during easy activities. Breathing may be harder when you lie flat. At night, you may wake up coughing or short of breath. You may need to sit up to breathe better.

• Swelling (edema) means your body is storing extra fluid. This could happen in your hands, abdomen, ankles or feet. Each person’s body carries water differently. Learn where you tend to swell.

• Fatigue occurs when your body doesn’t get enough blood. You may feel more tired and have less energy than usual, even when you’re less active.

Watch for ChangesOnce you’ve come up with your baselines, watch for changes daily. Pay attention to how much you can do today. Is it the same as yesterday? Are your shoes tight? Do you need to use a different belt hole? If today’s symptoms are different from your baselines, you need to take action. The problem won’t go away by itself. So, if you notice even a small change, don’t ignore it. Your health care provider is counting on you to call when you think your symptoms are worse. He or she will tell you what to do next. Working together helps keep heart failure under control and improves the number of good days you will have. It could even keep you out of the hospital.

You need to learn to watch for changes in your symptoms. If a problem occurs, you can get help before it becomes too bad. As long as symptoms stay about the same from one day to the next, your heart failure is stable. But if symptoms start to get worse, it’s time to take action. Work with your health care team to get heart failure back under control.

Your Role in TreatmentHeart failure treatment means more than just medication. You’ll also need to eat less salt, weigh yourself daily, measure your blood pressure and heart rate and manage your symptoms. Your job is to follow your prescribed treatment the best you can. To do this, you need to learn how heart failure affects your body and work closely with your health care team to keep heart failure under control. With practice and patience, you can take care of yourself, reduce symptoms and feel much better.

Weigh Yourself• Weigh yourself at the same time of day, every

day. The reading is most accurate if you weigh yourself soon after you get up in the morning, after urinating but before eating. You don’t need to weigh yourself more than once a day.

• Weigh yourself without clothes. If you do wear pajamas, a robe or a towel, be sure you wear the same thing every day. Otherwise, your weight won’t be accurate.

• Always use the same scale. Make sure the numbers are easy to read. There are also versions that audibly announce the weight. If you don’t have, or can’t afford, a scale ask your health care team for suggestions.

• Write down your weight each day. Keep your weight chart and a pen or pencil near the scale.

• Call your health care provider if you gain two or more pounds in one day, or five or more pounds in one week.

Measure Blood Pressure and Heart Rate• Sit comfortably with your arm supported on a

table. Put on the blood pressure cuff, following the directions that came with the device. Rest quietly for five minutes.

• Start the blood pressure device. Wait while your blood pressure is measured. Your heart rate may be taken, too.

• If the reading is very different from usual, wait five minutes. Then try again. Ask your health care provider what to do if this reading is also different from usual.

3

Setting and Meeting GoalsYou may feel overwhelmed by what you need to do to keep heart failure under control. Don’t try to do everything at once. Accept that change takes time. Changes may be easier to manage when you set small, realistic goals.

Setting Realistic GoalsTo reach your treatment goals, start small. Set goals you can really achieve. As you work toward goals, track your progress in a notebook or diary. When you reach a goal, reward yourself. This will help you stay motivated.

Take it Step by StepSometimes it helps to break big goals into smaller ones. For instance, one of your goals may be to eat only as much sodium as your health care provider recommends. Work toward this little by little and your realistic goals can add up to big success. Here’s how:1. Start by leaving salt out of your food. Take the

salt shaker off the table. If you have a container of salt in the cupboard, throw it away. Buy a few no-salt spice mixes. Also follow the tips on page 7 for cooking without sodium. When you’re comfortable with these changes, move on to your next small goal.

2. Next, cut back on high-sodium foods. Use food labels and the chart on page 7 to see which of the foods you often eat are highest in sodium. Slowly phase these out of your meals. Use the samples on page 7, or your own ideas, to swap high-sodium foods with healthier ones. Don’t try to stop eating all high-sodium foods at once. Instead, be realistic about what you can do.

3. Look for patterns in your eating habits. If you’re having trouble reducing sodium, your sodium log can show where you’re getting hung up. If you need help, show the logs to a family member or friend, your health care provider or a dietitian. Sometimes, an outside perspective can help.

4. When you get down to your daily sodium goal, celebrate. Reward yourself for a job well done. Go to the movies or a ball game with friends. Get a new blouse or a book you’ve been wanting to read. How else can you reward yourself?

Stay ActiveChoose your activityThink about the activities you discussed with your health care provider and choose the ones that appeal to you. You’re more likely to continue if you’re having fun.1. Walking is a good way to get oxygen moving through

the body. You can walk outdoors or indoors, such as around the house or at a shopping mall.

2. Swimming, water aerobics and light gardening are other options that may work for you.

3. If you’re too short of breath to do other types of activity, try chair exercises such as moving your arms and legs while sitting.

4. A cardiac rehabilitation program may be an option. This is a supervised exercise program that takes place in a medical center. It can help you feel more confident about how much your heart can handle. Ask your health care provider if you qualify.

Go

als • Stayin

g S

afe

4

Staying SafeFollow these guidelines to stay safe during activity:• Wear supportive shoes with padded soles and

arch support.• Wear a medical ID bracelet that lists your health

problems and any medications you’re allergic to.• If you feel fatigued or short of breath, stop and rest.

Return to the activity when you feel better.• Be aware of what’s happening around you. Exercise

with a friend – there’s safety in numbers. Keep a cell phone with you in case of an emergency.

Signs of OverexertionStop what you’re doing and get medical help if the following occurs:• Pain, discomfort, burning, tightness, heaviness

or pressure in your chest• Unusual aching in your arm, shoulders, neck,

jaw or back• A racing or skipping heartbeat• Shortness of breath that’s worse than normal or

doesn’t improve with rest• Extreme tiredness• Light-headedness, dizziness or nausea

Quitting SmokingIf you smoke, quitting is one of the most important changes you can make. Quitting reduces your chances of heart attack and other health problems. After you quit, you may feel better, have more energy and notice less shortness of breath. Quitting smoking isn’t easy, but millions of people have done it. You can too.

Have a “Quit Plan”Quitting takes patience and a plan. You’ll boost your chances of success by forming a “quit plan” ahead of time. Plan when you’ll quit, how you’ll deal with urges to smoke and who you’ll ask for support. You may also want to set a quit date (the day you’ll put your plan in to motion). One resource is an over-the-phone counseling service that is free of charge. Dial 1-800-No Butts to contact this service.

My quit date:

Sleep ApneaIf you have sleep apnea, your doctor may prescribe a continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BiPAP) device. These machines send a gentle flow of air through a nasal mask while you sleep. This air goes through your nose and into your lungs, keeping airways open.

Tips for Using CPAP and BiPAP• If your mask doesn’t fit or feel right, talk to

your doctor or the vendor about adjusting it or trying a new one.

• If you have allergies or other problems that block your nose, get those treated. These devices work best if your nose is clear.

• If the device doesn’t feel good or work well at first, don’t stop using it. Ask your doctor or someone from your medical equipment company for ways to help make it work for you.

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5

Yo

ur M

ed

icatio

ns • S

taying

in C

on

trol

6

Know What You’re TakingMany people take three or more heart failure medications. You should know certain details about each. This will help you take them correctly and safely. Ask your health care provider or pharmacist about anything you don’t understand or doesn’t seem right. For instance, if you get a refill and the pills don’t look like before, talk to the pharmacist before taking them. For each medication, ask:• What is the medication’s name? (Find out the

brand name as well as the generic name, if any.)• Why am I taking this? What does it do?• How often should I take this? At what time of day?• How much of the medication should I take? What’s

my dosage?• What should I do if I miss a dose?• Should I expect any side effects from this

medication? What should I do if I have them?• Do I need to follow any special instructions while

taking this? Are there any activities, foods or other medication I should avoid while taking this?

• How long should I keep taking this? When I run out, should I order more?

Staying in ControlTo manage heart failure, you’ll need to make a lot of changes. Sometimes you may feel like you don’t have control over your life or your health. Learning how to follow your treatment plan can help you regain some control. These suggestions may help, too:• Keep doing the things you enjoy, such as favorite

hobbies. If you stay busy with things you like to do, your mood will improve and life will be more enjoyable.

• Stay involved with friends and family. Try not to withdraw from the people around you, even if you’re finding it hard to talk to them. They can be good sources of support.

• Take an active role in your care. Bring up questions or concerns with your health care team. If treatment isn’t meeting your needs, other options may be available.

• Join a support group. It may be easier to talk to people who know firsthand what you’re going through.

Depression can be TreatedCoping with heart failure takes a lot of effort. This can affect how you feel. Some medications can change your mood, too. Having heart failure doesn’t mean you have to feel bad all the time, though. Talk to your health care provider or a therapist if you feel down most days or are having

problems with appetite or sleep. These are signs of depression. Treatment can help you feel better. When depression is under control, your overall health may also improve.

Sex and the HeartWhen you’re dealing with a chronic health problem, it’s not unusual to have trouble with sexual function. Erectile dysfunction is fairly common in men. In many cases, medication can improve sexual function. For women, products such as estrogen cream and lubrication can make sex more comfortable. Talk to your health care provider.

Your Emotional Health

It’s normal to feel sad or down at times.

Coping with a chronic health problem

is hard. To make heart failure and

treatment more manageable, just focus

on one day at a time. Don’t be afraid to

ask others for help when you need it.

The tips on these pages can help you

feel better emotionally. And, they’ll

help you maintain healthy relationships

with friends and loved ones.

7

Get Started With a Low-Sodium DietSodium (salt) from food and drinks makes your body store water. This causes swelling and forces your heart to work harder. To help prevent these problems, you have to eat much less sodium than you’re used to. Sodium enters your body in two main ways - from the salt you add to food and from foods that contain salt or other forms of sodium. To help your heart, you need to cut back on both sources. You don’t have to change your eating habits all at once. But you do have to start today.

Cook Without SodiumFor your taste buds to adjust, you need to decrease the amount of sodium in all of the foods you eat. These tips can help you get started: • Take the saltshaker off the table and stove. Note

that 1 teaspoon of salt contains approximately 2,400 mg of sodium. Season with fresh herbs, garlic, onion, lemon or pepper instead. A cookbook can give you other ideas.

• Don’t salt cooking water. When cooking pasta, add a splash of olive oil to the water instead of salt.

• Eat fresh or plain frozen vegetables. These have much less salt than canned vegetables.

• If you choose to eat high-sodium condiments, dip your fork instead of pouring them on foods.

• Be aware that some salt substitutes contain potassium chloride. This can cause problems with some heart medications. As a general rule, “salt substitutes” usually contain potassium chloride, whereas “salt-free seasoning blends,” such as Mrs. Dash, typically contain fresh herbs and spices without added potassium. Before trying a salt substitute, check with your health care provider or dietitian to make sure it’s safe for you.

My Sodium GoalYour health care provider will give you a sodium goal to meet each day. This includes sodium found in food as well as salt that you add.

My goal is to eat no more than mg of sodium per day. Usual recommendation is 2,000 mg or LESS if not otherwise specified

Watch Out for SodiumSodium can hide in foods that don’t even taste salty. Sodium is often found in the following:• Canned, processed and convenience foods

such as soups, lunch meat, frozen pizza, TV dinners and vegetable juice.

• Packaged pasta, noodle and rice dishes that contain a flavor packet or have flavoring mixed in.

• Mixes and seasonings such as gravy mix, instant mashed potatoes, cake mix, taco seasoning and some spice mixes.

• Salted snacks such as chips, crackers, popcorn, pretzels and salted nuts.

• Sauces and condiments such as ketchup, soy sauce, barbecue sauce, salad dressing and pickle relish.

• Bubbly liquids such as soda pop and some over-the-counter medicines (tablets that fizz in water).

Leave Sodium at the StoreMost people shop by habit. If this sounds like you, it’s time to turn off the automatic pilot. Avoid impulse buys. Make a shopping list before you go to the store. Start reading food labels. The following tips can help you while you shop: • In the produce section: Start your shopping here.

You’ll find a lot of delicious, low-sodium foods in this section. (Fresh vegetables and fruits have almost no sodium.)

• In the frozen food aisle: Plain frozen vegetables (without sauces) have very little sodium. However, frozen meals are often high in sodium.

• In the snack food section: These foods are often high in sodium. Look for low-salt versions of your favorite snacks.

• In the canned and packaged food aisles: Remember, these are often high in sodium. If you buy canned vegetables, look for varieties without added salt.

• At the meat counter: Look for fresh fish, chicken and meat. Avoid anything that’s cured, smoked or pre-marinated/seasoned. Even frozen meat can have added sodium. If you’re not sure, ask for help.

Nutritio

n

N u t r i t i o n F a c t sServing Size 1 cupServings per container 2

Amount Per ServingCalories 90 Calories from fat 20 % Daily ValueTotal Fat 2 g 3% Saturated Fat 0 g 0% Trans Fat 0 gCholesterol 10 mg 3%Sodium 890mg 37%Total Carbohydrates 13 g 4% Dietary Fiber 1 g 4% Sugars 1 gProtein 6 g

Ingredients: Chicken broth, carrots, cooked white chicken meat (white chicken meat, water, salt, sodium phosphate, isolates soy protein, modified cornstarch, cornstarch), potatoes, celery, rice, monosodium glutamate. Contains soy.

Percent daily value gives the

percentage of the standard

recommended amount per

day. If this is more than 25%,

the food probably contains

too much sodium for you.

Sodium is given in

milligrams (mg). How

does this number compare

to your daily goal?

Check the ingredients list

for salt. Also watch for

high-sodium ingredients

such as sodium phosphate,

brine, monosodium glutamate

(MSG), baking soda and any

other ingredient that has

“sodium” in its name.

The serving size is the

basis for all values on

the label. In this case,

1 serving is 1 cup (half

a can of soup). If you eat

the whole can (2 servings

or 2 cups), you have to

double all the numbers

on the label.

8

Using Food Labels to Meet Sodium Goals

Food labels can be very helpful as you try to meet your daily sodium goal.

Read them while you shop, then put high-sodium foods back on the shelves.

You can also use the information on food labels to track how much sodium

you eat in a day.

How to Read Food LabelsThe label below is from a can of soup. Get a package or can out of your cupboard; how does it compare to this one?

9

What About Cholesterol?Cholesterol is a waxy, fatlike substance. The body makes all the cholesterol it needs. Eating too much cholesterol can clog arteries and cause heart problems. Cholesterol is absorbed into the blood from foods such as egg yolks, organ meats and fatty animal products. Cutting down on these helps lower the amount of cholesterol in your blood and reduces your heart attack risk. The American Heart Association recommends less than 300 mg cholesterol per day and less than 200 mg per day if you have heart disease.

Slim Down Your MealsJust as you’re learning to cook with less salt, you can also learn to cook with less fat and cholesterol. Some foods may taste a little different at first, but you’ll get used to them. Try the following:• Bake, steam, microwave or broil foods instead

of frying.• Cook with olive oil, canola oil or trans-fat free

margarine instead of butter or normal margarine.• Before cooking, trim fat from meat and remove

the skin from chicken.• Chill soups and stews. Skim off the fat before

reheating and serving.• Try using half as much cheese as a recipe calls

for, or less. (This will also help you meet your sodium goal.)

• Remember that foods marked “low fat” can be high in sodium. Read food labels carefully, so you can stick to your sodium goal.

What do These Claims Really Mean?• Sodium free or salt free means less than 5 mg

per serving.• Very low sodium means 35 mg or less per serving.• Low sodium means 140 mg or less per serving.• Reduced sodium or less sodium means at least

25 percent less sodium than the standard version. (This could still be too much sodium for you. Look at the label.)

• Light in sodium means 50 percent less sodium than the standard version. (This could still be a lot, so read the label.)

• Avoid High Sodium foods with greater than 300 mg per serving.

• Unsalted or no salt added means no salt is added to the product during processing. (The product could still contain sodium. Be sure to check the label.)

• Healthy and natural have no nutritional meaning. Don’t be fooled into thinking that foods labeled this way must be good for you.

Choose Fats Wisely

Your body needs some fats to stay healthy.

But eating too much of certain fats is bad

for your heart. Try to choose the healthier

fats and avoid unhealthy ones.

Choose Limit Avoid

Type of fat Unsaturated fat Saturated fat Trans fat

Where it’s found

Nuts, seeds, fish, avocados, some

vegetable oils (such as olive,

canola and soy)

Animal foods such as beef,

pork, high-fat dairy, butter or cheese

Snack foods, french fries, and other fast food, shortening, most margarines

What you should do

Eat unsaturated fat some of the time. For instance, cook with olive or canola oil instead of butter.

Eat as little saturated fat as you can. To cut down,

choose fat-free milk and lean meats, chicken or fish.

Avoid foods with trans fat. Check

for it on food labels and on

the ingredients list in the form of

hydrogenated oils.

10

Dining Out

When dining out, be aware that it is difficult to control the amount of sodium in

your foods. However, you can ask about lower sodium menu options and request

no additional salt to be added to your food. Avoid condiments containing sodium

and certainly do not add any salt to your food. Portion control is also important.

By reducing the oversized portions served in restaurants, you will cut down on the

amount of sodium and fat you consume. So share with a friend, or take some home

for another meal.

11

Resources

The resources below can help you and the people close to you learn more about

heart failure, treatment and how to cope with a chronic health problem.

Scripps.org

http://www.scripps.org/heartfailurefaq

American Association of Cardiovascular

and Pulmonary Rehabilitation

www.aacvpr.org

American Association of Heart Failure Nurses

www.aahfn.org

American Association of Retired Persons

888-687-2277

www.aarp.org

American Heart Association

800-242-8721

www.americanheart.org/heartfailure

Heart Failure Online

www.heartfailure.org

Heart Failure Society of America

www.abouthf.org

Medicare Hotline

800-633-4227

Mrs. Dash

(low-sodium recipes and cooking tips)

www.mrsdash.com

National Coalition for Women with Heart Disease

202-728-7199

www.womenheart.org

Smokefree.gov

877-448-7848

www.smokefree.gov

Well Spouse Association

(for family members and other caregivers)

800-838-0879

www.wellspouse.org

Companies Offering Prepared Meals

*American Personal and Private Chef Association

www.personalchefsearch.com

*Dream Dinners

www.dreamdinners.com

Reso

urces an

d P

ersonal W

ork

sheets

12

My Contact List:

Primary Care Physician:

Cardiologist:

Pharmacy:

Other:

Other:

Other:

Questions for your health care team:

13

What’s Most Important to You?When you’re busy coping with daily life, it can be hard to see the big picture. Think about what matters to you. This will help you set priorities, manage daily life and plan for the future. Read each statement below. How important is it for you to do each of these things? Put a check mark in the column that best describes your feelings.

What’s Stopping Me?It’s easy to think of reasons why change is hard. Try to face your fears and excuses head-on. What’s stopping you from reaching your goals? Write down anything that comes to mind. Be as specific as you can. For each barrier to change, try to think of at least two possible solutions.

IMPORTANCE

I want to Very Sometimes Not Very

1. Care for myself.

2. Get out of bed every day.

3. Continue with favorite hobbies or activities.

4. Have energy to enjoy my children and grandchildren.

5. Go out on my own.

6. Spend time with family and friends.

7. Travel and see new places.

8. Manage my own expenses.

9. Decide things for myself.

10. Feel less anxious about my health.

11. Stay in my home as long as I live.

12. Live without a lot of pain.

13. Live without needing machines or medical devices

to keep me alive.

14. Live as long as I can.

15. Die peacefully and quickly if I’m very sick and have no

chance of getting better.

Change I want to make:

Become more active.Change I want to make: Change I want to make: Change I want to make:

What’s stopping me:

Afraid my heart isn’t strong enough.

What’s stopping me: What’s stopping me: What’s stopping me:

Possible solutions:

Ask my health care provider about

activities that are safe for me. Ask a friend

to take short walks together.

Possible solutions: Possible solutions: Possible solutions:

14

Symptom Action PlanTalk to your health care provider about what to do in case of worsening symptoms.

My baselines going home

Weight: Blood pressure: Heart rate:

If I notice I should

Weight gain of two or more pounds in one day, or five or more pounds in one week

Swelling (shoes or rings don’t fit, change in belt size)

Increased shortness of breath with activity

Unable to lie flat or breathe comfortably in bed

Decreased urination

Feeling much more tired than usual

Symptom:

15

My Symptom ChartA chart such as the one below helps you track your symptoms. Write down changes in your symptoms and any notes you think are important. Do this daily. This helps you see if your heart failure is worsening.

Bring the chart when you visit your health care team.

Example: Baseline Weight 180

Day WeightBlood

PressureHeart Rate Change in Symptoms/Notes

1 180 114/67 57 Ate out at a restaurant last night.

2 182 118/71 58 A little short of breath walking to the store.

3 184 115/68 57Short of breath. Swollen ankles,

shoes and socks tight.

4 185 118/70 65Lower legs swollen. Called doctor,

took extra water pill.

5 183 120/75 72Still some swelling, took extra

water pill as instructed.

6 180 130/80 72 Feel well. Swelling is gone.

7 180 125/75 70 Went for a walk. No shortness of breath.

My Symptom Chart: Week 1

Day WeightBlood

PressureHeart Rate Change in Symptoms/Notes

1

2

3

4

5

6

7

16

My Symptom Chart: Week 2

Day WeightBlood

PressureHeart Rate Change in Symptoms/Notes

1

2

3

4

5

6

7

My Symptom Chart: Week 3

Day WeightBlood

PressureHeart Rate Change in Symptoms/Notes

1

2

3

4

5

6

7

1. Scripps Memorial Hospital Encinitas 354 Santa Fe Drive Encinitas, CA 92024 Telephone: 760-633-6501 Emergency Services available

2. Scripps Green Hospital/Scripps Clinic 10666 N. Torrey Pines Road La Jolla, CA 92037 Telephone: 858-554-9100

3. Scripps Memorial Hospital La Jolla 9888 Genesee Avenue La Jolla, CA 92037 Telephone: 858-626-4123 Emergency Services available

4. Scripps Mercy Hospital San Diego 4077 Fifth Avenue San Diego, CA 92103 Telephone: 619-294-8111 Emergency Services available

5. Scripps Mercy Hospital Chula Vista 435 H Street Chula Vista, CA 91910 Telephone: 619-691-7000 Emergency Services available

Contact any of our five hospitals to learn more about our heart failure programs or call 1-800-SCRIPPS or visit us online at scripps.org.

1-800-SCRIPPSwww.scripps.org

©2011 Scripps Health (1/11) SMHLJ-578

100-8631-010SW